title: Reducing the decline in physical activity during pregnancy: a systematic review of behaviour change interventions.
abstract: OBJECTIVE
  Physical activity (PA) typically declines throughout pregnancy. Low levels of PA are associated with excessive weight gain and subsequently increase risk of pre-eclampsia, gestational diabetes mellitus, hypertension disorders, delivery by caesarean section and stillbirth. Systematic reviews on PA during pregnancy have not explored the efficacy of behaviour change techniques or related theory in altering PA behaviour. This systematic review evaluated the content of PA interventions to reduce the decline of PA in pregnant women with a specific emphasis on the behaviour change techniques employed to elicit this change.
  Literature searches were conducted in eight databases. Strict inclusion and exclusion criteria were employed. Two reviewers independently evaluated each intervention using the behaviour change techniques (BCT) taxonomy to identify the specific behaviour change techniques employed. Two reviewers independently assessed the risk of bias using the guidelines from the Cochrane Collaboration. Overall quality was determined using the GRADE approach.
  
  
  RESULTS
  A total of 1140 potentially eligible papers were identified from which 14 studies were selected for inclusion. Interventions included counselling (n = 6), structured exercise (n = 6) and education (n = 2). Common behaviour change techniques employed in these studies were goal setting and planning, feedback, repetition and substitution, shaping knowledge and comparison of behaviours. Regular face-to-face meetings were also commonly employed. PA change over time in intervention groups ranged from increases of 28% to decreases of 25%. In 8 out of 10 studies, which provided adequate data, participants in the intervention group were more physically active post intervention than controls.
  
  
  CONCLUSIONS
  Physical activity interventions incorporating behaviour change techniques help reduce the decline in PA throughout pregnancy. Range of behaviour change techniques can be implemented to reduce this decline including goals and planning, shaping knowledge and comparison of outcomes. A lack of high quality interventions hampers conclusions of intervention effectiveness.
authors.affiliation: Maternal, Fetal and Infant Research Centre, Institute of Nursing and Health Research, University of Ulster, Newtownabbey, Northern Ireland. Currie-S4@email.ulster.ac.uk
authors.forename: Sinead
authors.initials: S
authors.lastname: Currie
authors.forename: Marlene
authors.initials: M
authors.lastname: Sinclair
authors.forename: Marie H
authors.initials: MH
authors.lastname: Murphy
authors.forename: Elaine
authors.initials: E
authors.lastname: Madden
authors.forename: Lynn
authors.initials: L
authors.lastname: Dunwoody
authors.forename: Dianne
authors.initials: D
authors.lastname: Liddle
mesh_terms: D000223:Adaptation, Psychological; D015444:Exercise; D005260:Female; D006801:Humans; D009043:Motor Activity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D012307:Risk Factors; D057185:Sedentary Behavior